Endocrine Abstracts

Background: Adrenal vein sampling (AVS) is the gold-standard for localizing the site of autonomous aldosterone production in patients with primary aldosteronism (PA). The procedure is technically challenging with a reported success rate of 50-95%.

Aim: To audit the success rate of AVS at a regional referral unit.

Standards: No set standard exists. 80% success rate was taken as the minimum acceptable standard for a tertiary referral centre. This is the published, pooled average success rate from high-volume centres internationally.

Method: Patients who underwent AVS at our regional referral centre in 2019 were identified from the Radiology Information System (RIS) and their pathology results reviewed. AVS was deemed successful when the cortisol levels from both adrenal vein samples were at least double that of the sample taken from the low inferior vena cava. Samples were obtained sequentially with no ACTH stimulation via a femoral venous approach.

Results: 35 patients with a biochemical diagnosis of PA, aged between 35-74 years, underwent AVS. 33/35 (94%) AVS were successful. There were no major complications. The median fluoroscopy time was 11.1 min [3 min – 51 min]. The audit was repeated in 2020. 29 patients aged between 25-72 years underwent AVS in 2020. AVS was successful in 28/29 (96.6%) with no major complications. The median fluoroscopy time was 7.3 min [2.9 min – 22.9 min], which was significantly lower compared to the previous year (P = 0.02).

Conclusions: This audit shows that adequate experience and exposure of the operator is crucial in achieving optimal outcomes. AVS in our centre was performed by a single operator carrying out at least two AVS procedures per month. As with specialist surgery where better outcomes are achieved in high-volume centres, we suggest that AVS should only be carried out in selected high-volume centres by experienced operators.